New laws to fight Medicaid fraud in Illinois

On June 25, Gov. Pat Quinn signed into law legislation to encourage openness in the Medicaid program and to cut down on fraud, with a focus on allowing transparency.

These efforts are in line with President Barack Obama’s directive to expand and increase efforts to recapture funds that have been wrongfully paid out. The Department of Healthcare and Family Services says it is committed to maintaining faith in the Medicaid program by dealing with the fraud.

“I think what the public is demanding and what we are demanding of ourselves is program integrity,” said Julie Hamos, director of Healthcare and Family Services.

Her department uses the Office of the Inspector General to monitor the Medicaid program and attempt to cut down on fraud both by providers and clients. But the new laws should give the organization new options, like contracting third party groups to conduct audits.

The Illinois State Police believes that the bills should help supplement anti-fraud efforts that are already in place.

“These recent bills should serve as effective, additional tools that can be used to identify and recover fraudulent, stolen funds by allowing third parties to be contracted to audit and identify fraudulent claims,” said Capt. Scott Compton, a spokesperson for the Illinois State Police. “This will provide necessary assistance where there is a shortage of staff within the state government to handle the workload; although, it is just a part of an aggressive effort needed to gain control of the current Medicaid fraud epidemic.”

With so many people receiving Medicaid benefits, Hamos believes that fraud can creep into the system. “We have 2.4 million people on Medicaid. The possibility of fraud exists in many places,” Hamos said.

Hamos said she is primarily concerned about the way that the program can appear if it continues to be the subject of fraud, particularly if the crime goes without punishment.

“I think that it is a small percent of a large program, but even if it is a small amount, people could lose faith in the program,” Hamos said. “No matter how small, if we have fraud, we will lose our integrity with the public.”

The Illinois State Police, however, believes that Medicaid fraud is a more widespread problem for the state.

“Medicaid fraud has just recently been publicly acknowledged as a considerable problem nationally and for the state of Illinois; however, this criminal activity has been prevalent and increasing over the past 25 years,” Compton said.

In addition to depending on the Illinois State Police and the Inspector General to combat Medicaid fraud, there are some things that the public can do to prevent crimes.

“[Medicaid recipients] need to review their statements of services rendered which they receive in the mail,” Compton said. “When a discrepancy is identified, citizens need to contact the Illinois Department of Healthcare and Family Services or the Illinois State Police, Medicaid Fraud Control Bureau, and report their suspicions.”

The Illinois State Police also recommends not signing up for any Medicaid services over the phone and reporting anyone who attempts to sell services over the phone.